Heart rhythm · 2026
Heart failure risk stratification at the time of implantable cardioverter-defibrillator implantation after myocardial infarction: The HF WICD-MI score.
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Echivard Mathieu, Sellal Jean-Marc, McMurray John Jv, Ziliox Chloé, Monzo Luca, Lamiral Zohra, Duarte Kévin, Dickstein Kenneth, Pitt Bertram, Zannad Faiez, De Chillou Christian, Baudry Guillaume, Girerd Nicolas, WICD-MI Registry Group
Аннотация
BACKGROUND: After acute myocardial infarction (AMI) with left ventricular (LV) dysfunction, guideline-recommended reassessment at 40-90 days primarily addresses arrhythmic risk and implantable cardioverter-defibrillator (ICD) candidacy. In this setting, a complementary evaluation of heart failure (HF)-related event risk may refine risk stratification.
OBJECTIVE: We aimed to quantify post-ICD HF event risk and develop a simple score that is usable at the time of ICD decision.
METHODS: We analyzed 1015 patients from the WICD-MI study (41 French centers) with left ventricular ejection fraction of ≤35% after AMI who were equipped with a wearable cardioverter-defibrillator (WCD) and were subsequently implanted with an ICD. We hypothesized that early HF features after MI could predict subsequent HF outcomes and therefore assessed 5 preimplant HF features: HF history before AMI, cardiogenic shock or congestive HF during AMI, acute HF hospitalization during the WCD period, and New York Heart Association status at ICD implantation. The primary outcome was a composite of death or HF events (hospitalization, LV assist device, or transplantation) at 1 year post-ICD.
RESULTS: The 1-year risk of the composite outcome was 12.7%. All HF features except prior HF independently predicted the primary outcome: cardiogenic shock (adjusted hazard ratio [aHR] = 1.63, P = .013), congestive HF (aHR = 2.02, P = .0004), acute HF hospitalization (aHR = 2.96, P < .0001), and New York Heart Association III/IV (aHR = 1.64, P = .025). The risk increased from 5% (no points/HF features) to 38% (≥3 points/HF features). External validation in high-risk myocardial infarction (n = 22,418) showed improved discrimination for HF hospitalization vs Global Registry of Acute Coronary Events (ΔC-index +0.026; P = .001) and performance similar to that of VALIANT-HF, with greater simplicity.
CONCLUSION: In patients undergoing post-MI ICD implantation, a simple HF-based score identifies patients at a higher risk of early postimplant HF events and may support integrated management, including timely HF referral.
OBJECTIVE: We aimed to quantify post-ICD HF event risk and develop a simple score that is usable at the time of ICD decision.
METHODS: We analyzed 1015 patients from the WICD-MI study (41 French centers) with left ventricular ejection fraction of ≤35% after AMI who were equipped with a wearable cardioverter-defibrillator (WCD) and were subsequently implanted with an ICD. We hypothesized that early HF features after MI could predict subsequent HF outcomes and therefore assessed 5 preimplant HF features: HF history before AMI, cardiogenic shock or congestive HF during AMI, acute HF hospitalization during the WCD period, and New York Heart Association status at ICD implantation. The primary outcome was a composite of death or HF events (hospitalization, LV assist device, or transplantation) at 1 year post-ICD.
RESULTS: The 1-year risk of the composite outcome was 12.7%. All HF features except prior HF independently predicted the primary outcome: cardiogenic shock (adjusted hazard ratio [aHR] = 1.63, P = .013), congestive HF (aHR = 2.02, P = .0004), acute HF hospitalization (aHR = 2.96, P < .0001), and New York Heart Association III/IV (aHR = 1.64, P = .025). The risk increased from 5% (no points/HF features) to 38% (≥3 points/HF features). External validation in high-risk myocardial infarction (n = 22,418) showed improved discrimination for HF hospitalization vs Global Registry of Acute Coronary Events (ΔC-index +0.026; P = .001) and performance similar to that of VALIANT-HF, with greater simplicity.
CONCLUSION: In patients undergoing post-MI ICD implantation, a simple HF-based score identifies patients at a higher risk of early postimplant HF events and may support integrated management, including timely HF referral.